MS. ASTORE: Welcome to the Twin Cities and our town
hall meeting. And thank you for this unique opportunity to
answer questions about your health care program.

THE PRESIDENT: Well, thank you for giving me the
chance to do it. And I want to thank the people who are joining
us from Milwaukee and Detroit and Sioux Falls, too.

MS. ASTORE: We'd like you to start off the program
perhaps with some opening remarks.

THE PRESIDENT: I'll do that.

MR. MEIER: We turn it over to you.

THE PRESIDENT: Thank you.

First, let me say, I came here to Minneapolis late
last night, and I started the day off with a rally for health
care sponsored by the Nurses Association of Minnesota. Over two
million nurses in the Nurses Association have endorsed our health
care plan. And that's especially important to me because I
started out my interest in health care because my mother was a
nurse.

And then, many years ago when I started out in
public life, I was an attorney general, and one of my jobs was to
try to ensure good care within our nursing home system in my
state. Then as a governor, I had to worry about health care for
the poor through the Medicaid program, something Minnesota and
every other state has wrestled with.

About four years ago, a long time before I even
thought I'd be running for president, I agreed to take a look at
the health care system for the nation's governors to see what we
could do about it. And at that time, I talked to literally 900
health care providers -- doctors, nurses, hospital
administrators, paramedical workers of all kinds. And a lot of
businesspeople and health care consumers, people in every kind of
medical problem you can imagine. I became convinced then that
unless we had a national solution to a lot of our health care
problems, we wouldn't be able to solve them; that no state, even
the most progressive state, could solve all the problems of the
health care system without a national solution.

And let me just briefly say what I think the issues
are -- and a lot of them will be represented by people who are in
our four audiences tonight.

First of all, 39 million Americans don't have health
insurance at all, ever, during the year. And about another
100,000 a month are losing their health insurance permanently.
Secondly, at any given time in this nation of about 260 million
people, 58 million people won't have health insurance at sometime
during the year. Third -- and it gets worse as we go along here
-- about 81 million of us live in families with so-called
preexisting conditions -- a child with diabetes, a mother with
cancer, a father who had a heart attack early but still had to go
back to work. Those families either can't get insurance, pay
very high rates, or can never change their jobs because if they
change jobs they won't be able to get insurance in their new
jobs.

Fourth, small businesspeople and self-employed
people who have health insurance pay on the average 35 percent
more than those of us who are insured, who are government workers
or who work for bigger business. And 133 million of us have
health insurance policies with lifetime limits, which means that
if someone in our family should get real sick, we could run out
of our insurance just at the time we need it the most.

In addition to that, we're spending 40 to 50 percent
more of our national income on health care than any other country
in the world. The cost of health care to state and government
and to the federal government is exploding at two and three times
the rate of inflation. All the things I'd like to do for you as
President, in terms of investing more in education and training
and new technologies for the 21st century, are limited by how
much we have to put into health care every year to pay more for
the same health care.

There are lots of other problems. We have tens of
millions of Americans with disabilities -- some of them are here
-- who could work, who could be self-supporting, who get no help
for long-term care in their homes and who can't get health
insurance if they go to work. We have older people on Medicare
who need help with their medical bills and if they could get
medicine, they could stay out of hospitals and save us money and
have a better quality of life; but that's not covered. So the
question is, what are we going to do about this? Let me very
briefly tell you what I think we should do, then we'll open the
floor to questions.

First of all, I'm convinced that we can't solve any
of our problems until we deal with the basic one. We can no
longer be the only advanced country in the world that doesn't
provide health care security to all of our citizens all of the
time. If you want to do that, there are only two ways to do it.
You either have to have a system where you get rid of insurance
all together and have the government fund it, the way Canada
does; or you have to have a system of guaranteed insurance, the
way Germany does and several other countries. I advocate -- and
I'll explain why later -- I think we should have a system of
guaranteed private insurance with comprehensive benefits
including primary and preventive care, which saves a lot of money
in the long run; with no lifetime limits; and insurance that you
can't lose.

I believe that our system should maintain something
that's very important to Americans, which is the choice of
doctors and health care plans. More and more Americans are
insured in plans that deprive them of any choice of their
doctors; and that can be a serious problem. I believe there are
ways to control costs and protect choice. Our plan would
guarantee you at least three choices every year.

Third, we have to change insurance practices. We
have to make it illegal for people to have their coverage dropped
or benefits cut, for rates to be increased just because there's
someone in the family with a preexisting condition who's been
sick, for lifetime limits to cut off benefits, or for people who
are older to be charged more. This is a big deal. The average
person's going to change jobs eight times in a lifetime. A lot
of people are losing their jobs in their 50s and 60s and have to
get new jobs and can't get jobs because no one will give them
insurance because their rates are higher.

Fourth, I want to preserve Medicare, which keeps the
choice of doctors. But I also want to have Medicare begin to
cover prescription drugs, which it doesn't now, and phase in a
long-term care program not only for the elderly, but for
Americans with disabilities.

Finally, I think these health benefits should be
guaranteed in private insurance at work. Why? Because it's the
simplest way to get to universal coverage from where we are now.
Nine out of ten Americans with private health insurance are
insured through the workplace. Eight out of ten Americans who
don't have any insurance at all are in working families. So the
simplest way to cover this is to say, the employed uninsured
should have their insurance paid for by the employers and the
employees. The government should pay for the unemployed
uninsured, and should raise a pool of money to provide discounts
to small businesses who otherwise couldn't afford health
insurance. That's essentially our plan -- guaranteed private
insurance, the choice of the doctor, reform insurance procedures,
preserve Medicare, have health benefits guaranteed at work.

One last thing -- you have to find a way if you want
to reform the insurance practices to make it possible for
insurance companies to do these things, which means they have to
insure all of us in very large pools; and we have to let small
business people and self-employed people band together in co-ops
so they can bargain for the same good prices that those of us who
are insured through big businesses or government get. That's
essentially what we're trying to do in the Congress this year.

I've got an interest in ethics and redistribution.
I firmly believe that the redistributionist policy undermines the
basic sense of personal responsibility by transferring authority
for decisions -- crucial life decisions --from the individual to
the state. When a do-everything government assumes control of a
person's most personal responsibilities, we lose faith in our
capacity to make our own decisions. And we've seen the
deleterious effects of dependency upon -- of dependency upon an
institution such as --

MR. MEIER: Go ahead and ask your question.

Q Okay. My question is, is you plan really a
health plan or is it a power grab? I'd like the philosophical
arguments in support of your plan. I do not want to hear
compassion. I want something more concrete.

THE PRESIDENT: Well, compassion is part of my
philosophy. But anyway, philosophically, I don't believe the
government can solve all the problems for people; and I don't
think you should rob people of their personal responsibilities or
their personal choice. That's why I don't have a government-run
plan. It's private insurance. And people who don't have
insurance have the responsibility to provide it for themselves.

But I believe philosophically it is wrong for people
not to assume responsibilities for themselves and let other
people do it. And what's happening today -- let me just give you
two examples. Self-employed person x decides, well, I'm not
going to have any insurance. The they get in a wreck; they show
up at the emergency room; they can't pay. They could have had
insurance, but they didn't do it. That's fine for them, except
they get the care. Nobody let's them die; and nobody thinks they
should; and then the rest of us pay for it. And that is
irresponsible.

Another example: restaurant x and restaurant y next
together -- one covers the employees, the other doesn't. One is
fulfilling a responsibility not only to himself and the
employees, but to the rest of society by not asking us to bear
the risk of anybody getting sick; the other isn't. The other has
a competitive advantage in business. I don't think that's right.

And the system we have is not an individual
responsibility system, it's an irresponsibility system. I don't
plan to take over the health care system. I don't want the
government to run it. I think the government should help to
organize the markets so that small business people and selfemployed
people can afford to have insurance, and so that they
are not disadvantaged as compared with big business and
government. And I think it is irresponsible for people not to
provide for their own health care and irresponsible for the
government not to make it possible for people to do it not matter
what their station in life.

MS. ASTORE: Mr. President, this woman is a school
principal from St. Paul, and she's concerned about losing certain
benefits.

Q Good evening, President Clinton. I have been
real concerned about the health policy. I've followed it along
since your beginning presidency. I wondered about you and
Hillary's true concerns. I've been concerned that it might be a
political issue with you, and I wondered how it will affect all
Americans. Will we really receive better service? I wondered
about the people who have insurance. Will we have to pay more?
Will we get less then? Will we have less choice of doctors or
less of choice of hospitals? Will the doctors have less choice
of the services that they can provide? Will we have more
government debt? Will we have more taxes? I'm wondering if your
program is about controlling rather than better service. And I
realize that we in Minnesota are ahead of many states, but I do
have real concerns.

THE PRESIDENT: Well, let me try to answer two or
three of those questions -- you asked me ten at once so --
(laughter.) The only real tax we have in this plan -- we have to
raise funds to pay for the unemployed uninsured which we're all
paying for any way, folks. When they get sick, they wait until
it's too late, it's too expensive, they show up at the emergency
room and we pay.

Under our plan we would raise a fund to pay for them
and to pay for the discounts on small business from two sources
-- one, a tax on cigarettes, and the other, a modest assessment
on the biggest American companies that will get the biggest
windfall from this. That is, most big companies are paying way
too much in insurance now to subsidize the rest of us. They'll
get a windfall. We ask for a portion of that back to create a
fund for discounts for small business and for the unemployed
uninsured.

There will be more choice under our plan. This idea
that every American today has a choice of doctors is a myth.
More than half the American people who are insured in the
workplace today don't have a choice. They get one plan and
that's it. Ninety percent of the American people who are insured
in small businesses with 25 or fewer employees have no choice.
Under our plan there will be more choices.

That's one of the reason why so many medical groups
have endorsed this plan -- not just the nurses, but the family
practitioners, the pediatricians. Any number of other medical
groups have endorsed our plan because they know it guarantees
more choice.

Now, if you have a plan today that is better than
the one in our bill, you can keep it. In other words, if you
have a plan today where your employer pays 100 percent of your
health insurance, not 80 percent, and you continue to do that,
that's perfectly alright. We don't change that at all.

Q individual when you go for universal
coverage. If I already have a policy, isn't it true that it will
cost people that now pay for insurance more?

THE PRESIDENT: No, if you don't pay your premium,
if your employer pays all of your insurance now --

Q They don't pay all of my insurance, I carry
family coverage.

THE PRESIDENT: Well, the question is whether it
will cost you more. It depends on a lot of factors. In all
probability, you won't. All the -- not our studies, but all the
nonpartisan studies that have been done show that more than half
the people will get the same or better insurance for the same or
lower cost.

By and large, the people who will pay more are
people who aren't paying anything now, people who have only very
bare-bones coverage now, and young single workers will pay more
so that older people can pay less and we can have a large
community rating. Otherwise, most other people will pay the same
or less.

But if you have a better plan than we require, what
this does is put a floor under you. We've got -- keep in mind --
I don't know where -- I mean, I understand, I saw those ads
putting out all that propaganda, "this is just politics," "this
is just a power play," and all that. Tell that to these people
who are disabled who can't get insurance. Tell that to these old
people who choose between medicine and food every month. Tell
that to the 100,000 Americans a month who lose their health
insurance. Tell that to the farmers and the small businesspeople
who insure at 35 and 40 percent higher rates.

I mean, this is a bunch of hooey. If people don't
agree with me, let them come forward and contest me with their
ideas. But I am sick, and I think a lot of you must be sick, of
all this hot air rhetoric and all these pay television ads and
all these hit jobs from people who are making a killing from the
insurance business that we have today. It is wrong and we should
change it. (Applause.)

Let me just tell you something -- I don't go around
-- I don't mind doing this; I'll do this all night. But it never
gets -- one of the things I've learned in 20 years of public life
is you don't get very far questioning other people's motives.
Most people I've met -- contrary to what you read, most of the
people I've met in public life are honest, well-meaning. They're
not crooks and they're trying to do the right thing. We have
differences of opinion. But this health care debate, in my
judgment, has really been retarded -- in more ways than one --
(laughter) -- by all this motive throwing around we've had.

If I had wanted to take on a tough issue I could
have found something else to do with my time. I believe we have
to do this. And if we don't do it you're going to have more
people without insurance, more people that can't afford what
they've got, and a terrible situation in this country. And
that's why I did it. That doesn't mean I'm right, but let's
argue about what should or shouldn't be done and not talk about
other people's motives. I've even tried to convince the
insurance industry I don't want to attack their motives. I just
want us to argue about what we should do.

MR. MEIER: Mr. President, I want to direct you to
this side of the floor where you can look at that large monitor.
I want to give our live satellite audiences a chance to join in.
Let's go first to WDIV TV in Detroit, and Carmen Harlan.

Q Thank you, Randy. They were living the
American Dream. The Bertolones had two healthy children, a nice
home, and their own business. But in a matter of months, their
dream life changed.

(Film is shown.)

Three years later, Tony Bertolone lost his wife to
cancer. The family's last year together was spent battling the
disease and the insurance company.

(Film continues.)

That's when the battle began. Linda, Tony, and the
organization That's What Friends Are For began a letter-writing
campaign. Seven weeks later, the company changed its mind. But
the cancer had spread.

(Film continues.)

And to talk more about that pressure, Tony is with
us tonight. We used that video tribute that Tony made in his
story to his wife. It is a legacy for her children and for her
family. And as I said, Tony Bertolone is with us in the studio
with a question for the President.

Good evening, and welcome. What is your question?

Q My wife had advanced breast cancer. She was
told by a leading bone marrow transplant unit in the country that
they had a 25 percent chance of prolonged life extension if she
would receive the transplant. Our insurance company deemed the
procedure experimental and would not cover the expense. Would
women in a similar situation be told the same under your health
care plan?

THE PRESIDENT: It's an issue I'm very familiar
with. As you may know, my mother had breast cancer, and so I've
learned a lot about this issue. What we would cover under this
health care plan -- transplants of all kinds as long as the
doctors thought it was an appropriate procedure.

Now, there are some people who still believe bone
marrow transplants for breast cancer are experimental, although
there's a lot of evidence that it can prolong life among younger
women, especially women 50 and under. And the truth is that it
will depend upon the doctor's belief that it should be the
appropriate course of medical care. But what we're trying to do
is to give these decisions back to doctors and their patients who
believe it's an appropriate course of medical care. And I think
that it is clear that we're moving to the point where most
physicians believe that there are circumstances under which it is
an appropriate thing to do to give women with breast cancer bone
marrow transplants.

But I'm not trying to give you an evasive answer,
I'm trying to give you the standard that will be used in the
insurance policy -- is it appropriate medical care? Will the
doctor believe that? I think that more and more doctors do
believe that so, in most cases, I think you can look forward to
that kind of procedure being covered. Thank you.

MS. ASTORE: Let's bring the audience in Milwaukee
into the discussion now.

Q Thank you very much. It's been most
interesting thus far. Will Vanessa Donovan please come up? I'd
like to have you ask your question if you are here. Vanessa's
coming over now to -- step right this way, Vanessa, if you will
and I'll meet you sort of halfway here.

We are -- it will be interesting for the audience
here to know, they can't hear us in Minneapolis, which is more
than we've been able to say for much of the program. What was
your question for the President?

Q Okay, my main question is, a year ago, my
insurance was perfect. Shortly after your reform came into the
public eye, my insurance company notified us that in order to
keep our insurance the same, it would cost us $1440 more per
year. There's three doctors that I see on a regular basis --
they're specialists. I went Wednesday, and a big sign on his
desk said, in order -- you must have a current referral every day
-- I mean every appointment. And also I called my insurance
company and they said --

Q Can you get to the point of the question?

Q The question is if I have to pay for two
doctors' appointments, how is that cost effective?

Q Okay, thank you. Mr. President?

THE PRESIDENT: Well, first of all, let me say that
a lot of that referral business is probably because of
requirements that the insurance companies have put on the doctors
treating this lady. If you talk to any doctor, they'll tell you
that more and more and more, they're having to call insurance
companies and get permission to practice medicine in advance of
doing what they think has to be done anyway. Last night I was
down in Kansas City and I had three doctors in our group there,
and that's all they talked about was how much time they were
spending getting the approval of insurance companies to do what
they knew to do anyway.

You talked about how much your insurance had gone
up. Let me say, one of the best things about having a national
reform is that you can charge people the same price for an
individual policy and a higher price for a family policy, but you
would pay that price even if you had to use the doctor enough.
That's what insurance used to be.

I mean, when Blue Cross first got organized,
everybody was lumped in a great big pool, everybody paid the same
amount. Some people got sick and the rest of us paid for that as
well as a hedge against ourselves getting sick. Now we have 1500
separate insurance companies, thousands of different policies,
hundreds of thousands of people working in doctors' offices and
hospitals and insurance offices figuring out who's not covered
for what. So if you're in a little pool, and this lady -- you
heard what she said, she has an illness -- your rates can go way
up. If we're all insured in large pools, then your rates would
not go up unduly -- just more or less at the rate of inflation --
just because you had an illness. That's one of the -- this woman
would be dramatically advantaged if we had national insurance
reform -- health care reform.

MR. MEIER: Mr. President, I'd like you to meet this
46-year-old man from Milwaukee. He is HIV positive, the father
of two grown children. He is an unemployed factory worker, soon
to be without insurance. What is your question for the
President.

Q Mr. President, I want to say thank you for
bringing this to the forefront and Mrs. Clinton. My question is,
why can't the best of what the Canadian health care has and the
German health care have be brought to us as a package for the
American people?

THE PRESIDENT: Well, that's kind of what we're
trying to do. The Canadian system -- in Minnesota, for example,
where you're close to Canada, or in Michigan, or any of the
states that are in our program tonight, there are a lot of people
who would like to see the single-payer system that the Canadians
have.

The problem is twofold. One is, it would be very
difficult to get Congress to agree, in effect, to put all the
health insurance business in America out of business and
substitute it with a tax. And a lot of people like the lady who
asked the second question here would wonder what that would do to
their health care plans. Secondly, the Canadian system, in my
judgment, has not had quite as much success at controlling costs
as the German system has, where all the people pay something,
assume some responsibility directly for their health care, and
therefore negotiate more vigorously on an ongoing basis to try to
hold down the costs of health care.

But let me say from my point of view, sir, to you,
there are lots of people in America who are HIV positive who
could be working; who could be making a contribution and paying
taxes; who have difficulty doing that because they can't get
health insurance. But if they were insured in very large pools,
they would be able to do so.

So I think that one of the most important
beneficiaries of this policy will be people who have very serious
illnesses that still may permit them to work for long periods of
time and be active if they can provide for their own health care
needs.

MS. ASTORE: Thank you, Milwaukee. We have one more
live location to bring into our town hall meeting tonight on
health care.

Q Mr. President, we have with us tonight a person
who has perhaps slightly a nontraditional type of view of how
this might impact the health care industry. We have with us this
gentleman who is a chiropractor here in Sioux Falls. Your
question for the President.

Q Mr. President, 34 percent of the office visits
to practitioners according to the New England Journal of Medicine
are to nontraditional practitioners, such as chiropractors,
acupuncturists, massage therapists and nutritionists. How will
we be covered in your new health care plan?

THE PRESIDENT: Well, what we do in the health care
plan is to require certain kinds of care to be covered. And then
that care can be provided in a variety of different ways by
anybody who is qualified to provide it. What will happen is that
the people who band together in these purchasing alliances will
be given any number of choices from which the consumers of health
care can choose what kind of health care plan they want. So all
consumers will have the option, if they wish, to choose plans
that have different kinds of providers including alternative
providers, as you mentioned, to provide various health services.
We have to have -- everybody by law has a right to have three
different kinds of plans -- kinds of plans. But what you'll have
in most places is the kind of choices that now, for example,
federal employees have.

You know, a lot of federal employees can choose
between two dozen different plans. It's amazing. And as a
consequence of that, you have all different kinds of options and
a lot of providers, including chiropractors, have a chance to
provide services to people. That's the way ours would be set up.

Let me go right to the heart of the question because
I've got a lot of friends who are chiropractors who have asked me
this. We do not specify in the bill as it is presently drawn the
services of chiropractors, osteopaths, nurse practitioners or
neurosurgeons for that matter. What we do instead is say, here
are the kinds of health care services that have to be ordered,
let people organize themselves and offer them to the consumers of
America.

MR. MEIER: In South Dakota we're in an area that's
a lot more rural than the other areas represented in this
program. Tonight we have with us a woman who is a physician's
assistant in one of those rural areas.

Q Good evening, Mr. President. As a practicing
physician's assistant, I see significant increase in the cost of
health care as physicians, physician's assistants and nurse
practitioners practice defensive medicine in a litigious society.
Providers are obligated to order extensive tests and treatments
to protect themselves from potential malpractice suits. If
health care costs are to be reduced, attention must be directed
at health care, at tort reform. Will you health care plan
address this problem as health care reform becomes a reality?

THE PRESIDENT: Our plan does that in two ways. Let
me also mention, since we're talking to South Dakota and you've
got a lot of rural population, although we do here in Minnesota,
too, and in Michigan, the other states that are represented and
in Wisconsin.

Another big problem that we have in my rural state
where I'm from is that more and more general practitioners out in
the country are reluctant to do things like deliver babies and
set simple fractures because of the malpractice problems.

Our bill does two things: one is it sets a limit on
the percentage of a malpractice judgment that can be taken by a
lawyer, a percentage of the contingency fee; the second thing it
does, which I am convinced will have a far more positive impact
on insurance rates, is it sets up a system in which the
professional associations set up medical practice guidelines for
various kinds of cases. And then if the physicians can
demonstrate that they follow the guidelines, there is a
presumption that the physician was not negligent.

Now, that presumption can be overcome, but it is
much harder. And if that happens, we believe, that there will be
a substantial reduction in the number of frivolous cases in the
malpractice area, and therefore, malpractice insurance rates will
go down.

That's been tried in a rural state, Maine, with some
considerable success. And I think that it's the best way to go
to guarantee lower malpractice fees and still give people a right
to go into court when they've genuinely got a gripe.

MS. ASTORE: We're going to take this opportunity to
give the President a breather. So relax, we're going to take a
short break, and we'll be right back.

MS. ASTORE: Welcome back everyone to "Health Care
in the Heartland", our town hall meeting in the Twin Cities with
the President.

MR. MEIER: Coming up we have a profile of a person.
One of the scariest scenarios we've heard over and over again
from callers here in the Twin Cities is, what happens when
someone loses their health insurance during a time when they
really need it. And here's one such story.

( A film is shown.)

Q Mr. President, health care is certainly a
difficult issue and one that has many components to it. Can you
address how the new plan would handle insurance as you go from
one employer to another; and also how changes in the economy as
well as profitability of companies could handle and affect the
funding of the health plan.

THE PRESIDENT: Thank you very much. You know, this
is so interesting. Of all these forums that I've done, you're
the first person that's asked me that question. And let me try
to explain how it would work.

First of all, under our plan, companies would be
free to self-insure if they were above a certain size. We now
have 5,000 and above. There are some in Congress who think it
should be smaller. But what we have is complete portability of
benefits so that no family can never be without benefits. So
that if your company goes down and you don't have another job,
you just carry your benefits. And for the period in which you're
between jobs, this reserve fund that I talked about that we'll
set up, the government basically would provide the reserve to
guarantee that your coverage would continue just as if you were
still working at the other company. So you would not have been
put in the position that you're in now.

And it's very important. In addition to people who
are in the position that you're in, where your company went broke
and you got left with all those bills, there are an awful lot of
people who just want to change jobs, but they have to wait for
months and months and months, even after they change jobs, before
they actually get coverage. So this is a big issue.

We need to guarantee -- the term of art is
portability -- complete portability of policies through jobs and
through employers. And our system would provide that.

Thank you.

MS. ASTORE: Mr. President, this gentleman is from
North St. Paul, and he's concerned about benefits to immigrants
to this country. Your question.

Q Mr. President, in your health care plan, you
say you want all Americans to get involved in the process of
planning so that all American citizens will benefit from the
plan. However, there are -- adult literacy surveys indicate
there's 21 to 23 percent of adult or 40 to 44 million adults were
less skilled level. And 25 percent of adult or 10.5 million
adults were immigrant with limited English skills. And I ask,
what is your plan to insure or access to your health plan system
for this unique American citizen and alien resident?

THE PRESIDENT: Most of those folks, even with very
limited English capacity, have jobs. So they would get -- at the
job site -- a card, a health care card, just like everyone else;
which they then would be able to present to their doctor. They
would have the opportunity either at work or at a local health
clinic to have explained to them what their choices are of the
health care plan, and then they would just -- they wouldn't have
to keep up with a lot of paper or anything, just one card for the
family that they could present at the health care clinic when
they needed it, or at the hospital. So I think that's the way
it will work.

Now, in many places where there are a very large
number of people whose first language is not English, we will
have to expand the outreach activities of the public health
clinics for people who are not employed, and where there's no one
in the family who is employed. And we understand that we're
going to have to do that and make some provision for doing that.
Thank you.

MR. MEIER: Mr. President, we're going to join our
satellite audience one more time in Detroit and station WDIV.

Q And first we want to apologize for the audio
problems that we've been experiencing here in Detroit. We are
working very closely with the people in Minneapolis to get that
corrected, we ask that you do be patient and stay with us.

Right now we're going to take a question for the
President from this woman who is the Secretary for the National
Association of Engineering Companies. And what is your question
for the President tonight?

Q Mr. President, I would like to know how
prescription coverage will be affected under the plan outside of
Medicare?

THE PRESIDENT: Under our plan, every health policy
would have to have a prescription drug component which would have
the following characteristics: There would be a $250 deductible.
In other words, you have spend up to $250 of your own money on
medicine before it would trigger in. And then after that, every
prescription would require a 20 percent co-pay. But there would
be a ceiling beyond which you could not spend -- it's about
1,000. If your expenditures went over $1,000 a year, then the
insurance policy would cover all the prescription drugs that your
doctor would require and that your health would require.

So it's a pretty good policy, because -- now, if you
have a better policy now, you can keep it. Keep in mind, if the
coverage is better now, you can keep it. But almost no one has
coverage that good today in their health care policy for
prescription drugs. And there are a lot of national studies
which show that the adequate provision of prescription medicine
can actually save money by reducing hospital stays and emergency
room visits.

MS. ASTORE: Okay, now, since we got that question
out, we've got another one for you, Mr. President. It's from
this woman who is an American citizen living in Windsor. And
what is your question for the President tonight?

Q I wonder if he knows about Ontario's latest
plan that preventage of medicine consists of community health
centers run by the community, staffed by salaried practitioners,
concentrating on long-term health problems within each community.
They're running 49 such centers at a cost approximately the same
as a large hospital.

MS. ASTORE: And that's in Canada.

Q This is in Ontario.

THE PRESIDENT: I think that one of the things that
will happen if we pass this bill is that you will have more and
more health care provided in that way by community-based clinics
or comprehensive health centers that have salaried professionals,
including doctors. Interestingly enough, we're here in
Minneapolis -- that's what you have at the Mayo Clinic, right?
Everybody concedes that there is no finer health care in the
world. And yet I have many people who have been patients at the
Mayo Clinic tell me that it is less expensive than they what they
paid back home for other kinds of care.

So I think that you will see a lot more of that in
this country once the health insurance market is organized so
that people know they will always be reimbursed for the services
they provide. That then permits people to organize these kinds
of associations and know that they'll be able to run them without
going broke, because they know they'll always have reimbursement.

Q why this woman moved there to begin with,
right?

Q That's true. It was an unexpected bonus.

MS. ASTORE: We're going to go back now to our
Milwaukee audience.

Q Thanks. There are people in Milwaukee who have
already taken health care reform into their own hands. With me
now is this doctor. And the clinic he works in is a model for
the Clinton health plan, and is already making a difference here
in Milwaukee.

(A film is shown)

Q Dr. Sanchez, what is your question for the
President?

Q Mr. President, do you feel it is important to
preserve the established network of community health centers
across the country? And if so, how do you address this in your
health plan?

THE PRESIDENT: Yes, I do. Not only for the reasons
we just saw in the fine practice you have, but because the
community health centers are increasingly providing services to
large numbers of people who used to not use them at all. For
example, in many of the southern states of this country,
including mine, over 80 percent of all the children in the states
get their immunizations through community health centers, because
a lot of regular doctor's offices don't do it anymore because of
the malpractice problems that were mentioned earlier.

So I think it's very important. And our plan has a
special provision for funding community health centers at a
higher level to try to make sure that these kind of comprehensive
services can be provided.

And let me emphasize, too, that in the inner city
and in rural areas -- we've got South Dakota here, remember, on
this television program -- if it weren't for community health
centers there would be no access to health care; so that people
might have insurance but they still wouldn't have any place to go
with their insurance. So it's very important.

Thank you for practicing there.

MR. MEIER: Our next question's from this gentleman,
who is a cigarette and grocery supplier. And you have a question
with regard to the tax on cigarettes, which is being discussed in
regard to this.

Q Mr. President, this country was based on
tobacco farmers exporting their product overseas. Today it's
been proven that the people least likely to afford cigarette
smoking are the ones that are left smoking today. Why would you
place such an unfair burden on one group of people and one
industry to pay for all this?

THE PRESIDENT: Well, as I said, first of all, let
me say if I could figure out how to get enough savings out of
this program to pay for it without any tax, that's what I would
do. We are going to get dramatic savings out of this program,
mostly by having a single form, simpler administration, which
will save the taxpayers a lot of money; and those of you who
aren't taxpayers who have private insurance, by drastically
cutting the amount of administrative overhead in the system.

We cannot, however, provide enough money to do the
things that we've been discussing without raising some money.
Obviously, I think it is fair to ask the companies that will have
the biggest drop in their insurance premiums to give a small
portion of that to the fund for small business discounts and for
unemployed people.

The reason that I think that the cigarette tax is a
legitimate place to get funds is that cigarette smoking is the
only activity that we know of in our society that there is no
know safe margin for doing. That is, it's not like alcoholic
consumption where if you're not prone to be an alcoholic there
are safe margins of consumption. We know of no safe measure of
smoking. And we also know that several thousand people year get
lung cancer from subsidiary exposure to smoke, when they don't do
it themselves. We also know that our society bears a health care
burden and cost as a result of the health care consequences of
smoking far in excess of the money raised from the cigarette tax.
So for all those reasons, I thought since we had to raise some
money, that was the fairest way to do it.

MS. ASTORE: There are millions of Midwest residents
who live in rural areas who have some unique issues when it comes
to health care. Mr. President, we're going to take another
break; we'll talk about that when we come right back.
(Applause.)

MR. MEIER: And welcome back to "Health Care in the
Heartland," our town hall meeting in the Twin Cities with
President Bill Clinton, obviously.

We're going to toss it out to Sioux Falls, South
Dakota, where we have more questions for you from the heartland.
Mr. President.

Q South Dakota is among the most rural states in
the nation. We have several hundred thousand people spread out
over the entire state, not just in one city. Small business
people, the self-employed and those with existing medical
problems all have a big stake in the health care reform problems.

(A film is shown.)

Q We're back now and we have with us a farmer
from South Dakota, and he has a question for the President.

Q Do you have it built into your plan to
encourage more organ donation amongst -- to get more organs
available and when they do become available, to use for
transplants? That's my question.

THE PRESIDENT: Yes, sir. We support transplants as
I said, let me restate -- particularly organ transplants. We
support transplants when they are the recommended medical
procedure, and we try to provide ways to make sure that we
facilitate that.

Now, let me also say to you since you were
introduced in a slightly different way -- as a farmer who's selfemployed,
who has already had a medical problem, who has folks
working for you on the farm. Farmers, in my opinion, may be the
biggest winner in the proposed reform we have because today,
believe it or not, self-employed people who buy health insurance,
number one, pay exorbitant rates anyway because they're not in
big pools. If they've been sick, they pay lots more. And if
you're self-employed, you can only deduct 25 percent of your cost
of the premium from your income taxes whereas a business can
deduct 100 percent.

Under our plan, you'd be able to buy on an equal
basis with others in a much bigger pool and you would be able to
deduct 100 percent of your self employed premium which means in
almost every case in the country, farmers would be able to insure
their farm hands for the time they work for them and their
families for less than they're paying just for family insurance
today. And you certainly would because of your preexisting
condition.

But, let me just say this, I will try to get some
more information on the specific question you asked me about
encouraging and organizing the whole market for transplants. And
I will make sure that we get back to you in the next day or two
with a more specific answer to your question.

Q Mr. President, also joining us today is the
president of the South Dakota's Farmers Union.

Q Thank you. It's nice to have you around, Mr.
President. It was nice to have your wife here previously. It
was an excellent opportunity for the people of South Dakota.

One of the things that concerns many of us is,
number one, to maintain the farmers out there, but as the farmers
are maintained, to require them or have the ability to have the
infrastructure in the small towns. As I understand it, this plan
will provide monies to develop that infrastructure. Would you
please elaborate?

THE PRESIDENT: Yes, I'd like to talk about that a
little bit. And I'd like to say, first of all, my wife had a
wonderful time out there. And I want to thank Senator Daschle
for doing such a good job and working on this rural health care
issue.

Let me try to explain how this would work, and let
me say for the rest of you, a lot of people who live in small
towns in rural areas don't even have a doctor in their town
anymore. I met in rural North Carolina earlier this week a
doctor who told me she was working 110 hours a week and had been
several weeks, but she had just come to her slow season when she
could work 80 hours a week. Now, that's a doctor who's going to
need a doctor pretty soon, right? (Laughter.)

Here's what we try to do. Let me briefly run
through the things that are in this plan for rural areas. Number
one, revive the National Health Service Corps where young doctors
can pay for their medical education which normally leaves them
with a big debt by serving in underserved areas -- 7,000 doctors
over the next few years doing that.

Number two, give doctors and other health care
providers who go into underserved areas significant income tax
credits as incentives to do it -- $1,000 a month for doctors,
$500 a month for nurses and other medical professionals for up to
five years. That's a huge incentive. Number three, give doctors
faster write-offs, tax write-offs when they buy modern equipment
to put into their clinics in rural areas.

And number four, make sure that we've got the
technology, the computer technology to connect rural clinics with
urban medical centers so doctors can feel good about the quality
of their practice when they're out there and feel like they're
giving their patients the kind of care they need.

Those are the things that we think will get a lot
more doctors and nurses and other into rural America and make a
big difference.

Q Mr. President, we also have another farm group
in South Dakota that is quite large, the South Dakota Farm
Bureau. And we have along with us tonight Gayle Brock from the
Farm Bureau.

Q Mr. President, I would like you to ask you to
comment on Medicare and Medicaid. They are often underreimbursed
in the rural areas for those that provide care in the
rural areas. And how can these providers then be adequately
compensated and still save over $100 billion, as you have
outlined in your financing proposal on these two programs?

THE PRESIDENT: Well, for one thing, Medicare and
Medicaid are going up right now at two and three times the rate
of inflation -- by far more than inflation and population growth
-- because primarily of the way the Medicaid program is
organized. Under our plan, Medicaid recipients would be put into
big insurance pools along with all other -- along with small
businesspeople, self-employed people, and larger business people.
In other words, they'd be put in these big community pools. And
doctors, for the first time, would be reimbursed at the same rate
whether or not they had a Medicaid patient or someone who was
privately insured. It would be exactly the same reimbursement.
And that would make a huge difference to the physicians.

Secondly -- and how would we do that and still save
money? Because you'll have competition; you'll have managed
competition, which we've seen already in Minnesota with the work
that's been done here. You had dramatic drop-off in the increase
in medical costs here as people have organized themselves into
larger groups.

Secondly, under Medicare, we leave it the way it is
because so many of the people that I have talked to in the AARP
and the other groups believe Medicare works and want it left
alone. But we do add a prescription drug benefit and we add a
long-term care benefit.

How will rural doctors be able to deal with this?
They won't have any more uncompensated care. One of the things
that makes Medicare and Medicaid a bigger burden in rural areas
is there are an awful lot of uncompensated care in rural areas.
Now doctors will be paid something by everybody they treat. And
I believe that that will make a big difference to the quality and
rewards of the practice of medicine in rural areas.

We can save this money -- to go back to your
question -- by the way we organize the health care markets and by
making sure that everybody is reimbursed for all the services
that are provided. Then we'll be able to lower the rate of
inflation.

Keep in mind, we don't propose to cut Medicare and
Medicaid, ma'am. Medicare and Medicaid under our proposal would
go up at twice the rate of inflation, instead of three times the
rate of inflation, which it's going to do if we don't pass
national health care reform.

MS. ASTORE: Back here in the Twin Cities, Mr.
President, we have a question from a woman of St. Paul. She's
concerned about the importance of mental health care under your
program.

Q Mr. President, initially, mental health care
seemed to be an important part of health care reform. But
recently I haven't heard much about its inclusion within the
reform package. My question is, is mental health care an
important part of health care reform; where and how is it going
to fit in?

THE PRESIDENT: Yes, it is a very important part of
health care reform. We have -- under our plan, some mental
health benefits would be included from the beginning of national
health reform. That is, whenever -- all the states would have
until the end of '97 to provide universal coverage. Each state
would have that time. From the beginning of the time everybody
was covered, there would be significant mental health benefits,
much more than most people have under their policies today --both
in-patient and out-patient care.

There would not, however, be complete parity. And
if you're interested in mental health, you know -- parity
between the mental health benefits and the physical health
benefits until the year 2000. And that's because we don't have
accurate cost estimates on how much it will cost and we have to
phase it in. To go back to what some other people had said
earlier, we have to know that when we put these things in that we
can pay for them and we're not going to cost the Treasury more
than we have.

But there will be quite a significant mental health
benefit from the very beginning and much more than most people
have today. I think it's very important. I think it's one of
the best things about our plan, and I personally believe it will
make us a healthier country and will cut down on long-term
medical costs if we have proper kind of mental health.

MR. MEIER: Mr. President, if I could have you do an
about-face -- (laughter) -- and direct your attention right up
here. We had a lot of questions about costs of a national health
care when we organized this forum. Brian Malloy is from
Minneapolis, and I believe he'd like to ask you a question on
that topic.

Q Mr. President, we already have Minnesota Care
in this state and we've enrolled 30,000 Minnesotans in this plan.
Are we going to lose money under a federal plan? Would we be
better off to continue with Minnesota Care independent of a
federal initiative?

THE PRESIDENT: No, you won't lose money because --
and I commend what you've done; I think it's important. But you
won't lose money. We estimate that both private insurers and the
government will save money if we go on with national health care
reform. And what will happen is if we have the national plan,
we'll be able to do some things that at least you're not now
doing.

First, everybody will be able to be insured. And,
secondly, in addition to holding costs down, we'll be able to
hold costs down with more choices for health care consumers than
you're going to be able to provide unless we have a national plan
which reorganizes the insurance markets. So my judgement is,
you'd be -- I would urge you to keep going with you reforms here
to do the best you can and go full out until the Congress acts.
But I believe you'd be much better off when the Congress acts.

MS. ASTORE: Mr. President, another question from
Minneapolis.

Q Mr. President, untreated addiction is a huge
factor in the rising cost of health care. The American Medical
Association tells us that about 40 percent of hospital days and
over 50 percent of emergency room visits are for alcohol or other
drug-related causes, illness or accidents. I'd like to know with
your benefit for a substance abuse treatment which, as you
mentioned, is there now -- along with the mental health -- you've
been taking a lot of flack on the cost. But we know that
treatment cuts medical utilization in half immediately not only
for addicted persons, but for their whole family members. Can
you do a better job of defending that? And how far are you going
to go to keep this benefit in the final legislation on health
care reform?

THE PRESIDENT: I don't know if I can do a better
job of defending it. Some days I don't think I do such a hot
job. (Laughter.) I did my best when we started tonight, but I'm
going to try. Let me say -- I think you may know this -- but I
have a brother who is an addict, who is a recovering addict. I
know the treatment works.

And we have done two things in our administration.
One is to require that drug treatment be a part of the benefits,
as a part of a general approach to preventive health care. I
believe in preventive health care, folks. We spend a ton of
money after the cow's already out of the barn door in our health
care system. And I like -- I mean, I like the fact that we have
the best technology in the world. I like the fact that we can
get it. But we can save so much money if we just invest in
prevention generally, whether it's mammograms for women or
cholesterol tests for people or substance abuse treatment.

In addition to that, although I just presented a
budget to the Congress that cuts defense and cuts discretionary
domestic spending -- that is, not Medicare, Medicaid or Social
Security -- for the first time since 1969. We increase in our
regular budget drug treatment funds by, oh, about 8 or 10
percent, just because I think it is so important. And I will
fight very hard for it. I think it would be a big mistake for us
to back off of this. There's still an awful lot of people who
have alcohol and drug abuse, substance abuse problems in this
country. And we can save a bunch of money and a lot of people,
more importantly, if we stay with it.

MR. MEIER: Before we move on, we want to apologize
to our satellite audiences. We understand they've been
experiencing some technical difficulties. We know how important
this forum is. And we apologize for that.

In the meantime, let's move onto Detroit for another
audience there.

Q All right. I know from Detroit, we really do
thank you for that. With me is this woman, and she's been
waiting patiently for quite awhile. She's a mother of five, a
grandmother of one. You've lived in Detroit for 30 years, you
work with senior citizens. What's your question for the
President tonight?

Q My question, Mr. President, is, will there be
coverage for seniors for medication, and full coverage, in fact,
for those people who are most likely to need it?

I work in an office where I see seniors who are
going to doctors maybe three, four times per month, and they can
hardly afford to eat if they buy their medication. Will there be
some type of relief or help with medications for those people.

THE PRESIDENT: Yes, ma'am. Let me explain this
again for the benefit of all of our participants here. Older
people who are at or below the poverty line are eligible for
coverage under the Medicaid program, the government's program for
poor folks. If you're under Medicaid, then you have a
prescription drug benefit. But if you're a senior citizen
eligible for Medicare --that is, the regular elderly person's
health care program -- and you haven't spent yourself in poverty,
you don't get any prescription drug benefit. But we know that
older people are four times as likely to use medicine as younger
people. And we also know that we save money in our health care
system if people who need medicine get it and can therefore stay
out of hospitals. I mean, you can spend a year's worth of
medicine in three days in a hospital.

So what our plan does is to add to Medicare a
prescription drug benefit, which has a $250 deductible, a 20
percent co-pay and, I think, a $1,000 ceiling -- it has a ceiling
and I think it's $1,000. That is, after you spend $1,000 out of
pocket, your insurance then will cover all your medicine from
then on.

MS. ASTORE: Okay, our next question comes from a
health economist at the U. of M. School of Public Health -- the
University of Michigan. Welcome, and what's your question for
the President?

Q Well, my question is, one of the important
principles behind health care reform is that an increasing
reliance on competition to control costs. However, what we see
in many markets already is consolidation of insurers and
providers into larger and larger groups. My question is, what
steps would you advocate to ensure that, in a situation that
seems to be evolving to even very large cities having two or
three big players in the health insurance market -- what steps do
you advocate to ensure the competition will remain viable in the
long term?

THE PRESIDENT:
First, let me say, I think there has to be some consolidation of
the insurance market. To be fair, I've tried to say this over
and over again -- and sometimes not so well -- but, I don't think
there are any bad people in this drama. We have the best health
care in the world -- we have the best doctors, the best nurses,
the best medical technology, the best medical research. We have
the worst health care financing system in the world. It is the
world's most expensive; it's estimated by nearly everybody that
studies it that we spend about $90 billion a year -- which is
pretty good money -- in clerical work, simply because of the way
we're organized.

I think there should be and will be, inevitably,
some sort of insurance consolidation. How do we guarantee
competition? By requiring that in every group of buyers, every
consumer in America have access to at least three different kinds
of plans -- a fee-for-service plan, a health maintenance
organization, a professional provider organization.

They may have access to 24 specific plans -- as I
said, the way the federal government employees often do today --
but we will guarantee that every person always has access to at
least three different kinds of plans, including fee-for-service
in the old-fashioned way. When you do that, you're going to
ensure that there will be more competition than there will be.
If we do nothing, the move toward competition, in my judgement,
will be just exactly what you say -- there will be more and more
concentration, more and more managed care, but less choice, less
quality and less competition.

MS. ASTORE: Now, we've heard from an American who
moved to Canada. Our next question comes from a Canadian who has
moved here to America. You owns a small business, and what is
your question for the President?

Q Mr. President, you have said that I will not
have to give up my doctor. Right now, my family uses several
doctors. Under your plan, what if these doctors work for
different alliances in my area? Won't I be forced to choose
which alliance I want to join and thereby give up one of the
doctors I now see?

THE PRESIDENT: No. But let me answer your question
directly. First of all, one option you will always have, ma'am,
is to continue to pay your doctors as you would now, on a feefor
-service basis. Your premiums might be slightly higher, but
they probably still would be as low, if not lower, than they are
today because of the way the markets are organized.

In addition to that, you can also join a certain
plan -- like a certain health plan -- and maybe all your doctors
aren't members of it, let's say three are but one of your
specialists aren't. You can buy a small premium, which would not
be very expensive, which would give you the right also to use
that doctor, who would then get reimbursed from your plan at the
same rate other doctors in the same specialty or the same area
would.

So you would be able to keep all your doctors. That
would be one of the things you'd have to do. You might have to
pay slightly more to do it than you would otherwise pay. But you
could keep them all and, in all probability, based on our
studies, it would be for the same or less money than you're
paying now.

Q I think we should mention that we have one of
the friendliest --

THE PRESIDENT: If you have a comprehensive plan.

Q international borders, probably, in this
country between Detroit and Windsor, Ontario, Canada. Back to
you in Minneapolis.

MS. ASTORE: Thank you. We'd like to go now to our
Milwaukee audience at WISN-TV.

Q Thanks, she is a 29-year-old college graduate.
She is the mother of three, she is bilingual, she wants to work,
she can't find a job and begins to think that maybe we're
approaching the wrong problem first.

Q Yes. Mr. President, my concern is welfare
reform. As it is true with any reform effort, the basic purpose
for welfare reform is to increase and expand the opportunities
and benefits for the people on it to enable them to be selffunctionable.
Therefore my question, Mr. President, how does
your proposed welfare reform program expand and increase the
opportunities for myself -- a welfare recipient who has went to
high school, has received a high school diploma; who has attended
and graduated a state-accredited four-year university, has
received a Bachelor of Arts degree in Communication, bilingual in
Spanish; who has also acquired computer proficiency in
WordPerfect, Work Express, Wendalls, Lotus --

THE PRESIDENT: My guess is we've already done it.
I'll bet you'll have four job offers tomorrow since you've been
on television. (Laughter.) I imagine we probably solved your
problem. But let me give you a more general answer. I hope
somebody who's watching you will call you and offer a job
tomorrow.

First of all, quite apart from welfare, we have to
create more jobs in this country. In the last 15 months, our
economy has produced two and a half million new jobs -- 90
percent of them in the private sector, more than in the previous
four years. So we're creating more jobs. That's the first
thing.

Secondly, with regard to welfare, how do you move
people from welfare to work? You have to make work more
attractive. We, this year, starting in this calendar year, we
are lowering income taxes for 16.6 percent, one-sixth of American
workers who make lower wages to make sure that work will always
be more attractive than welfare by saying, if you work for modest
wages, you'll get an income tax cut.

The third thing we are trying to do is to reform the
welfare system itself by helping to create jobs ultimately for
people who have training and are able to go to work, if
necessary, with some sort of public funding. But let me say, it
doesn't apply to you.

But the biggest problem we've got with welfare for a
lot of people is that -- remember, if you're poor on Medicaid and
on welfare, your children get health care. If you take a minimum
wage job in a business that doesn't have health insurance, you
have to give up your kid's health care to go to work. Then you
work for a minimum wage and you pay taxes so people on welfare
can have health care. It doesn't make any sense. So, the health
care issue is an important part of welfare reform.

The answer to this lady's question is she should be
able to get a job in a healthy market economy. So we have to
create more jobs. Ultimately, for people on welfare who are
willing to go to work, if they can't find jobs within a certain
specific time, in my judgment, the government is going to have to
work with the private sector to give extra incentives for people
to go to work. It's better to have work than be on welfare even
if you have to give extra incentives to create the jobs.

Q Our next person who would like to ask you a
question is this gentleman. He's 17 years old, still in high
school, has done a great deal of research on this entire project,
and has drawn the conclusion that it will not work. (Laughter
and applause.)

Q Good evening, Mr. President. I don't know if
that's exactly correct, but how will you nationwide health care
program affect the American free enterprise system as we know it?
Will it simply be a case of government stepping in and improving
the status quo while maintaining the private business -- private
health care industry? Or is it more like a reinvention of the
American health care -- improving conditions for Americans, but
hurting the private business sector?

THE PRESIDENT: I think it will do much more good
than harm. There will be some job loss in some areas, and there
will be some job gain in some areas. And let me explain how and
why I think it's the right thing to do.

First of all, the system is entirely private. We
require people to purchase insurance. We keep private insurance.
We do not abolish insurance and substitute taxes. Secondly, all
the health care providers that are now private will continue to
be private. So we leave that alone. But if you go to a
comprehensive benefit program where you have a single form that
the doctor has to fill out, a single form that a hospital has to
fill out, a single form that a patient has to fill out, and
everybody is clearly covered by producing a card, then all those
people who are busily at work trying to figure out who's not
covered under what health insurance policy; or why the health
insurance policy needs to be cut off; or why a small pool can't
anymore support a person who's got a sick child -- those jobs
will go down in number dramatically. But we'll have a big
increase in jobs in health care providers -- people who work in
home health, for example.

Some small businesses will pay more because they
don't pay anything now or they have very limited policies now.
But on average, it will add 1 to 2 percent to their cost of doing
business, and all their competitors will have to do the same
thing. And within a few years they'll all be saving so much more
because medical inflation will be less.

The Congressional Budget Office is a nonpartisan
group that did a study on this. They estimate that on average,
within five years we'll be creating many more jobs in the small
business sector because we'll lower medical inflation and all
small business people will be on equal competitive terms.

So I think there will be some job loss, more job
gain in the short run in health care, and big job gains over the
long run by bringing health costs in line with inflation.

Q Mr. President, our next participant is not
looking for work. He provides jobs. He is providing also the
prospective of tonight's program of the small business person in
small town America. This gentleman is an auto dealer in Platt,
South Dakota, a town of about 1,300 people. Your question for
the President.

Q Good evening, Mr. President. Most big
businesses in corporate America provide health insurance for
their employees and also millions of retirees with pretax
dollars. My concern is the cost this is going to probably have
on your plan. If the Clinton plan becomes law, would this
release of the liability of businesses from providing health
insurance to retirees, and if so who does pay for it?

THE PRESIDENT: It would relieve them of some of
their responsibilities for paying for the early retirees. And
they would be in the retiree pool in our health care program.
But I still believe it's good economics, because a lot of these
companies are paying now 15, 16, 17, 18 percent of their payroll
as compared with the national average of 8 to 8.5 percent of
payroll for health care. And that is undermining their ability
to reinvest money and to create more jobs and to make our economy
stronger.

Most of those companies that are severely affected
by this are companies like automobiles and steel, which had to
have huge layoffs through early retirement all during the 1980s
to be competitive. In other words, it wasn't a decision they
made, it was necessity. And they had contracts which required
them to carry these health burdens.

We believe for relatively modest cost we can
generate a huge amount of money in these sectors, which are now
prospering, to create more jobs and help strengthen the American
economy. So we think that it'll be about a wash that we can well
afford.

Let me say, sir, that we have had the cost of our
plan evaluated by any number of people, including groups that are
composed largely of folks that were active in the previous two
Republican administrations. And all of them say more or less the
same thing -- that over the 10-year period, our numbers are
right. The differ from year to year sometimes, but I think that
the cost figures in my plan are good because we've bent over
backwards, we've contacted 10 different medical actuarial firms
and also had a lot of outsiders look at it. I think the numbers
are right.

MS. ASTORE: Thank you, Sioux Falls. Mr. President,
we have time for one final question here in the Twin Cities. And
we'd like you to pick a member of the audience to ask that final
question. (Laughter.)

Q I'm from Dayton, Minnesota. And one word I
haven't heard the whole time I've been listening to the news
programs about the plan is dental. And I'm a person whose teeth
have not been kind to me. And that's my major medical budget in
my household for myself is teeth. And I'm really concerned about
that. Is there going to be any thought or any kind of provision
at all for that type of medical care, because that can affect
your health.

THE PRESIDENT: Yes -- we're running out of time. I
can't give you the whole details. But the short answer is yes.
You'll have to pay some of it, and I'll get you the details.

Q Thank you, Mr. President. I have a handicapped
daughter. She grew up with severe handicap. And as she's
getting older -- she's out on her own right now -- but she cannot
get any type of medical help whatsoever from anywhere. I'd like
to know what your plan has that will help her to be able to
succeed in life and do what she wants to do and still have
coverage.

THE PRESIDENT: What's her handicap?

Q Right now it's a form of scoliosis. She's got
a severe curvature; she's had a back spinal fusion amongst other
things.

THE PRESIDENT: Your daughter would be able to buy
insurance as an individual once she be becomes an adult on the
same terms as anybody.

Now, the only way we can do that is if we organize
the insurance markets and the buyers so that they're big
insurance pools and large numbers of buyers so we can spread the
risk of some future illness or problem of hers across a large
number of people.

I do want to make full disclosure, because one of
the first questions I got was who would pay more under this plan.
We would ask young single workers to pay a little more per month
than they would otherwise pay so that we'd be able to insure
people like your daughter and older workers on affordable terms.
I think, again, that's a fair thing because young, single workers
want to be older some day, number one; and they're going to be
married, they're going to have children, and they might have
children that have health problems.

So I think it's a fair thing to do. But that's the
way it would work. That's the way, by the way, other countries
do it. And your daughter would be able to get insurance.

MS. ASTORE: President Clinton, we're coming to the
end of our town hall meeting. We'd like to give you this
opportunity to offer some closing remarks.

THE PRESIDENT: I just want to make two points after
I say, thank you to all of you. Thank you to those of you who
asked questions and those who couldn't get your questions asked.

For those of you in the other sites, if you had a
question that didn't get answered, send it to us and we'll answer
it. And those of you that are here, I'll just gather them up
while I'm here. (Laughter.)

I want to make two points if I might. We can differ
about the details of this, but the one thing that we have to
decide on as a people is, are we going to continue to be the only
advanced economy in the entire world that can't figure out how to
provide health insurance for all of its people so that we insure
people and pay for them if they are on welfare, but we punish
working people. Or are we going to solve this problem after
talking about it for 60 years now?

The second thing I want to say is this -- to go back
to a point I made at the beginning. This is a complicated issue.
I've tried to shoot straight with you and tell you what the
problems are with it. I respect people who have differences of
opinion with me on exactly how we should do it.

But what I want to ask you to do is to try to
communicate to your members of Congress, without regard to party,
that Republicans and Independents and Democrats all get sick, all
have kids, all have parents, all have hopes, all have fears; and
that it's okay for us to disagree about this in terms of the
details, but it is not okay to let another year go by and not
deal with it.

And what I ask you to do is not so much to say, Bill
Clinton's right about everything. But to say, this is a serious
problem, we have to deal with it, please act now. We will not
know any more about this next year than we do this year. It's
just going to be like an ingrown toenail. It will get worse, not
better, if we don't move.

So that is what I plead with you to do. Ask your
members of Congress to act now and to work in the spirit of
humanity, bipartisanship and common sense and let's get this
done.

Thank you very much. (Applause.)

MR. MEIER: Thank you, Mr. President. I'm sure
we've all enjoyed this opportunity to meet with you tonight.
It's a very important issue, and I thank we all learned something
here tonight.

MS. ASTORE: We hope by getting together tonight,
we've helped to shed some light on this complicated issue for our
live audiences and our viewers on the satellites.